April 29, 2014

Medication Reminders – What is the Minimal Effective Dose of Technology?

As I type this, I am sitting on a park bench in Toronto’s Roundhouse park, a sanctuary for old steam and diesel engines in front of the state-of-the-art Metro Toronto Convention Centre.
I’m here with my daughter, who is currently busy repurposing a steam train playground installation as a boat. Behind me, traffic crawls along the Gardiner Expressway which cuts off the Waterfront and its condos and building sites from Downtown.

I am at the 2014 CHI conference on Computer-Human Interaction, which is one of the largest conferences on making technology useable.

On Monday morning, the conference opened with a very thought provoking keynote by Margaret Atwood on robots, technology, and humans. One of the many points she made was about unexpected perspectives on familiar technologies. Just as my daughter converted a train into a boat, technology is invented for one purpose, but then can serve many others. The true potential of a thing is an unknown unknown, in Donald Rumsfeld’s words. It’s a wide open space, limited only by creativity and serendipity.

At alt.chi (on Tuesday before lunch), I’m going to argue that what helps us remember to take our medications is not shiny new purpose built apps – rather, we need to delve into the unknowns and be creative, so that remembering medications is as little work as possible.

(The mathematically inclined readers among you can now imagine using your favourite approach to minimising a differential equation.)

As Juliet Corbin and Anselm Strauss argued in a series of seminal papers, there are three layers of work associated with illness. First, there’s the illness work proper – taking medications, doing prescribed exercises. Then, there’s everyday work – roughly, getting on with your life while being ill. Finally, there’s biographical work – work on your own identity and values. Not to mention that being ill means that you are drained and, by definition, not able to function at your best.

Illnesses create additional everyday and biographical work. Take people with diabetes. They need to schedule regular checkups with their health care providers, take prescribed pills, and remember to refill their prescriptions on time. They may need to overhaul the way they eat. This can mean spending more time preparing and sourcing foods that won’t aggravate their illness – so more everyday work. Finally, they need to come to terms with their diagnosis. Often, they will need medication for the rest of their lives. They need to cut back radically on cakes and sweets. What’s worse, in public discourse, people with diabetes are often stigmatised as fat slobs who ate themselves sick.

So, assume they forget their pills. Let’s just install a smartphone app, shall we? But what about people who struggle to work their phones (and they’re not all elderly)? What about people who rarely use their phones (again, they’re not all elderly)? There are many reasons why smartphone apps can and will fail – and a common denominator of many of them is that using those apps (indeed, using a smartphone) is too much work.

Work on top of work, while the person who has to do the work is not at their best.

Let’s be honest – how do you remember to take your medication? Do you use technology? If it works for you, great.

But what if it doesn’t?

What if the most effective dose of technology is not one app, but none?